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While the United States experiences physical distancing under the coronavirus pandemic, the 3.2 million American citizens in Puerto Rico experience multiple types of distancing – physical, economic and political. Many on the island say “corona got nada on us,” reflecting on their resilience to overcome significant adversity over the past three years. How is COVID-19 affecting the people of Puerto Rico? Let’s take a glance at the events of the last few years and the approach of the federal and local governments today.
I still remember waking up to videos of my hometown, Juncos, flooded by water. Unable to contact my loved ones, I waited two whole months before hearing from them. It was Sept. 20, 2017. A Category 4 hurricane had hit the island with massive destruction and over 30 hours of non-stop heavy rain and wind. When it finally moved away, Hurricane Maria was recorded as the worst natural disaster to touch the island in over 80 years. For 11 months, 80 percent of the island’s populace lived in the dark, “…the largest blackout in U.S. history, and the second-largest blackout in the world.” Drinking water was scarce, and fortunate were the people who had access to clean water. Roads collapsed, hindering people from moving, checking in on their loved ones, finding resources, or even seeking medical assistance.
The hurricane forced more than 130,000 Puerto Ricans to seek refuge in the continental United States. While Puerto Ricans were welcomed with open arms in states like New York, many were discriminated against and even denied fundamental rights like a driver’s license in the state of Georgia.
Three years later, nearly 20,000 families still don’t have stable homes; they live under FEMA blue tarps that act as “roofs.” The death toll resulting from the hurricane became a political mockery. The governor of Puerto Rico at the time, Ricardo Roselló, who was removed from office by the people, referred to the dead bodies at the morgue as “cadavers to feed our crows.” With little political will, the death toll is still unknown and controversial. However, a study conducted by the New England School of Medicine (funded by Harvard T.H. Chan School of Public Health and others) estimates a death toll of 4,645 “more than 70 times the official estimate.”
Not surprisingly, this took a heavy toll on the island’s health care system. Compared to the United States, Puerto Ricans are more likely to have poorer general health, 34 percent compared to 18 percent. Puerto Ricans have a 50 percent higher diabetes rate and four times higher prevalence of HIV than the continental U.S. In fact, in 2014, Puerto Rico reported the highest rate of people living with HIV compared to the 50 individual state totals. The percentage of people living with a disability is estimated at nearly double that of the U.S (15.4 percent compared to 8.6 percent in the U.S. overall). While most Puerto Ricans rely on Medicare and/or Medicaid, the lack of adequate funding for those programs creates barriers to access, quality and affordability of care for people.
As the health care system and the economy collapsed during and after the hurricane, many health care professionals fled to the continental United States seeking employment, which also left a critical shortage of medical providers on the island.
My 90-year-old abuela, with pre-existing conditions, was left untreated. She moved to the states to receive medical assistance. Her case is not unique. In fact, this exemplifies exactly how the U.S treats Puerto Ricans as second-class citizens.
If that wasn’t enough, on January 7, 2020, the entire island felt a 6.4 magnitude earthquake, reported as the strongest quake of the century on Puerto Rico. The destruction on the southern coast of the island internally displaced more than 8,000 individuals – from infants to older adults. Nursing homes improvised shelter under plastic tents in 90-degree weather, and families and children created homes under palm trees in their front yards. Schools have been closed since the earthquake. Thus, Puerto Rican children have not been in an academic setting in all of 2020 – remote learning was adapted under COVID-19 quarantine restrictions in early April.
On Monday, May 2, another major earthquake – 5.5 magnitude this time – hit the south coast of the island, creating yet more destruction and misery. While there are people who are still living in refugee tents, the land continued to shake every day with aftershocks. On top of unprecedented and recurring natural disasters, Puerto Rico was now also dealing with COVID-19, like the rest of the world.
To reduce the spread of COVID-19 on the island, Gov. Wanda Vazquez enacted two executive orders with very strict lock-down regulations. For two months, all non-essential businesses closed and people were required to stay indoors from 9 p.m. to 5 a.m. “…unless they have to buy food or medicine, go to the bank, or have an emergency or health-related situation. Violators faced a $ 5,000 fine or a six-month jail term, and police have cited hundreds of people.” The strict guidelines received a lot of media attention with mixed reviews. While some were pleased with the strong stance, the ACLU filed a lawsuit against the Puerto Rican government arguing that some of the restrictions were unconstitutional.
Businesses gradually started to re-open during the week of May 18. As cases continued to rise, mainly due to arriving travelers, the Governor announced travel restrictions requiring passengers arriving in Puerto Rico to have been tested before travel. Those who cannot provide a negative must quarantine for 14 days in Puerto Rico. The concern of public health professionals is that Puerto Rico ranks the lowest in COVID testing in all of the United States and territories. Even if the number of cases seems steady, there isn’t enough data to support the re-opening of the economy. As of June, only approximately 11,000 people had been tested for COVID-19, an average of 15 coronavirus tests a day for every 100,000 people on an island with 3.2 million citizens. That’s simply not enough testing. To date, Puerto Rico has recorded 7,465 confirmed cases with 153 deaths. The total number of cases has changed throughout the weeks, as the Puerto Rico Department of Public Health admitted to erroneously miscounting positive cases. What will happen next remains the big question.
The health care system of Puerto Rico is not equipped to handle a spike in coronavirus cases. While still recovering from the series of natural disasters, under a 13-year recession, and inequitably treated by the federal government, the island lacks the infrastructure to provide for its citizens. Therefore, it is up to us, as advocates, to raise awareness. The world has seen the resilience of the people of Puerto Rico. Around the world, everyone knows Puerto Rico as a land rich in music, great food, beautiful beaches, the perfect honeymoon spot, family vacation destination, or even venue for a conference. But do people care enough to advocate for the people of Puerto Rico?
Puerto Ricans want to be heard. Puerto Ricans want to be seen – beyond what we give to the world. The people of Puerto Rico are experiencing yet another hardship that we can’t ignore. As Puerto Ricans would say, basta ya! Enough is enough. If we truly care about advancing health equity in the United States, we must include the people of Puerto Rico.